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Methotrexate with or without misoprostol to terminate pregnancies with no gestational sac visible by ultrasound
Author(s) -
Wiebe Ellen R.
Publication year - 2009
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2009.04.015
Subject(s) - medicine , misoprostol , citation , gestational age , library science , abortion , pregnancy , genetics , biology , computer science
not significant (9.2% vs 6.2%; P=0.073). The neonatal outcome among grand multiparas compared with multiparas indicated a significantly higher incidence of low Apgar scores at 1 and 5 minutes, and higher late fetal mortality (2.8% vs 0.1%; P=0.002), but a lower incidence of major congenital anomalies and neonatalmortality comparedwithmultiparous women (Table 2). The incidence of infections, birth injures, acidosis, and intracranial hemorrhage was similar between the two groups. The present study showed that grand multiparity was associated with lower socioeconomic status and poor prenatal care, which resulted in a greater number of perinatal late fetal deaths. Insufficient prenatal care may explain the higher incidence of late fetal death in grand multiparous women. If we exclude the higher incidence of cesarean deliveries and low Apgar scores, we did not find any differences in pregnancy, delivery, puerperal or neonatal complications among the offspring of the grand multiparous women. In contrast, Fuchs et al. [3] reported increased fetal andmaternal morbidity, and a higher incidence of obstetric complications and operative deliveries compared with the general obstetrics population. This difference is probably due to the different control groups. Other studies have reported a higher incidence of pregnancy and obstetric complications with good perinatal outcome [2,5]. These studies concluded thatwith improved socioeconomic status and a high standard of prenatal care, grand multiparity does not necessarily carry special obstetric or perinatal risk [2–4]. The main limitations of the present study are the relatively low number of grand multiparous women included and the retrospective analysis. The results suggest that most of thematernal and fetal adverse effects found to be linked with multiparity in our population may be attributed to socioeconomic factors rather than to parity. However, in our community, grand multiparity still carries an increased risk of operative delivery and perinatal mortality.